Quality of Life Research

, Volume 28, Issue 12, pp 3187–3195 | Cite as

Evaluating a falls prevention intervention in older home care recipients: a comparison of SF-6D and EQ-5D

  • Maria BjerkEmail author
  • Therese Brovold
  • Jennifer C. Davis
  • Astrid Bergland



Health-related quality of life (HRQOL) is an important outcome in economic evaluations of health care interventions for older adults. The aim of this study was to compare two commonly used preference-based utility measures, SF-6D and EQ-5D, to provide knowledge on their applicability when evaluating falls prevention interventions in primary health care.


The study is a secondary analysis of longitudinal data from a randomised controlled trial, which included 155 older home care recipients participating in a falls prevention intervention in Norway. HRQOL was measured by SF-6D and EQ-5D. Physical function was measured by Berg Balance Scale, 4-m walk test, 30-s sit-to-stand and Falls Efficacy Scale International. Assessments were performed at baseline, 3 months and 6 months. The agreement between SF-6D and EQ-5D was examined using Bland–Altman plots and Spearman correlations. Elasticities from regression analysis were employed to compare the instruments’ responsiveness.


SF-6D and EQ-5D were strongly correlated (0.71), but there were differences in the instruments’ agreement and domains of HRQOL covered. Participants with a higher mean HRQOL and/or better physical function scored generally higher on EQ-5D. Participants with a lower mean HRQOL and/or poorer physical function achieved a relatively higher score on SF-6D. EQ-5D was more responsive to changes in physical function compared to SF-6D.


SF-6D and EQ-5D have both similarities and differences regarding sensitivity, domains covered and responsiveness to changes when evaluating a falls prevention intervention. Selecting the appropriate instrument depends on the characteristics of the participants and the intervention being evaluated.


Health-related quality of life Home care Falls prevention Economic evaluation SF-6D SF-36 EQ-5D 



This study did not receive external funding. Internal funding is provided by the OsloMet – Oslo Metropolitan University. The institution had no role in the design, conduct of research or decision of publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The project proposal has been approved by The Regional Committee for Medical Research Ethics in South East Norway (Ref. 2014/2051).

Informed consent

Written informed consent was obtained from all participants before baseline testing.


  1. 1.
    World Health Organization. (2015). World report on ageing and health. Geneva, Switzerland: World Health Organization.Google Scholar
  2. 2.
    Kannus, P., Sievänen, H., Palvanen, M., Järvinen, T., & Parkkari, J. (2005). Prevention of falls and consequent injuries in elderly people. The Lancet,366(9500), 1885–1893. Scholar
  3. 3.
    Stenhagen, M., Ekstrom, H., Nordell, E., & Elmstahl, S. (2014). Accidental falls, health-related quality of life and life satisfaction: A prospective study of the general elderly population. Archives of Gerontology and Geriatrics,58(1), 95–100. Scholar
  4. 4.
    Davis, J. C., Best, J. R., Dian, L., Khan, K. M., Hsu, C. L., Chan, W., et al. (2017). Are the EQ-5D-3L and the ICECAP-O responsive among older adults with impaired mobility? Evidence from the Vancouver Falls Prevention Cohort Study. Quality of Life Research,26(3), 737–747. Scholar
  5. 5.
    Bjerk, M., Brovold, T., Skelton, D. A., & Bergland, A. (2018). Associations between health-related quality of life, physical function and fear of falling in older fallers receiving home care. BMC Geriatrics,18(1), 253. Scholar
  6. 6.
    Fletcher, P. C., & Hirdes, J. P. (2004). Restriction in activity associated with fear of falling among community-based seniors using home care services. Age and Ageing,33(3), 273–279. Scholar
  7. 7.
    Hektoen, L. F., Aas, E., & Lurås, H. (2009). Cost-effectiveness in fall prevention for older women. Scandinavian Journal of Public Health,37(6), 584–589. Scholar
  8. 8.
    Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. Scholar
  9. 9.
    El-Khoury, F., Cassou, B., Charles, M.-A., & Dargent-Molina, P. (2013). The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: Systematic review and meta-analysis of randomised controlled trials. BMJ,347, f6234. Scholar
  10. 10.
    Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes (4th ed.). Oxford, UK: Oxford University Press.Google Scholar
  11. 11.
    Brazier, J., Roberts, J., Tsuchiya, A., & Busschbach, J. (2004). A comparison of the EQ-5D and SF-6D across seven patient groups. Health Economics,13(9), 873–884. Scholar
  12. 12.
    Haywood, K., Garratt, A., & Fitzpatrick, R. (2005). Quality of life in older people: A structured review of generic self-assessed health instruments. Quality of Life Research,14(7), 1651–1668. Scholar
  13. 13.
    Gerard, K., Nicholson, T., Mullee, M., Mehta, R., & Roderick, P. (2004). EQ-5D versus SF-6D in an older, chronically ill patient group. Applied Health Economics and Health Policy,3(2), 91–102. Scholar
  14. 14.
    Petrou, S., & Hockley, C. (2005). An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population. Health Economics,14(11), 1169–1189. Scholar
  15. 15.
    van Stel, H. F., & Buskens, E. (2006). Comparison of the SF-6D and the EQ-5D in patients with coronary heart disease. Health and Quality of Life Outcomes,4(1), 20. Scholar
  16. 16.
    Cunillera, O., Tresserras, R., Rajmil, L., Vilagut, G., Brugulat, P., Herdman, M., et al. (2010). Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey. Quality of Life Research,19(6), 853–864. Scholar
  17. 17.
    Chen, J., Wong, C. K., McGhee, S. M., Pang, P. K., & Yu, W.-C. (2014). A comparison between the EQ-5D and the SF-6D in patients with chronic obstructive pulmonary disease (COPD). PLoS ONE,9(11), e112389. Scholar
  18. 18.
    Kontodimopoulos, N., Pappa, E., Papadopoulos, A. A., Tountas, Y., & Niakas, D. (2009). Comparing SF-6D and EQ-5D utilities across groups differing in health status. Quality of Life Research,18(1), 87–97. Scholar
  19. 19.
    Lamers, L., Bouwmans, C., van Straten, A., Donker, M., & Hakkaart, L. (2006). Comparison of EQ-5D and SF-6D utilities in mental health patients. Health Economics,15(11), 1229–1236. Scholar
  20. 20.
    McDonough, C. M., & Tosteson, A. N. (2007). Measuring preferences for cost-utility analysis: How choice of method may influence decision-making. Pharmacoeconomics,25(2), 93–106. Scholar
  21. 21.
    Joore, M., Brunenberg, D., Nelemans, P., Wouters, E., Kuijpers, P., Honig, A., et al. (2010). The impact of differences in EQ-5D and SF-6D utility scores on the acceptability of cost-utility ratios: Results across five trial-based cost–utility studies. Value in Health,13(2), 222–229. Scholar
  22. 22.
    Bjerk, M., Brovold, T., Skelton, D. A., & Bergland, A. (2017). A falls prevention programme to improve quality of life, physical function and falls efficacy in older people receiving home help services: Study protocol for a randomised controlled trial. BMC Health Services Research,17(1), 559. Scholar
  23. 23.
    Bjerk, M., Brovold, T., Skelton, D. A., Liu-Ambrose, T., & Bergland, A. (2019). Effects of a falls prevention exercise programme on health-related quality of life in older home care recipients: A randomised controlled trial. Age and Ageing,48(2), 213–219. Scholar
  24. 24.
    von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gotzsche, P. C., Vandenbroucke, J. P., et al. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. The Lancet,370(9596), 1453–1457. Scholar
  25. 25.
    Loge, J. H., & Kaasa, S. (1998). Short Form 36 (SF-36) health survey: Normative data from the general Norwegian population. Scandinavian Journal of Public Health,26(4), 250–258. Scholar
  26. 26.
    Walters, S. J., & Brazier, J. E. (2005). Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Quality of Life Research,14(6), 1523–1532. Scholar
  27. 27.
    The EuroQol Group. (1990). EuroQol - a new facility for the measurement of health-related quality of life. Health Policy,16(3), 199–208. Scholar
  28. 28.
    Brazier, J. E., & Roberts, J. (2004). The estimation of a preference-based measure of health from the SF-12. Medical Care,42, 851–859.CrossRefGoogle Scholar
  29. 29.
    Berg, K. O., Maki, B. E., Williams, J. I., Holliday, P. J., & Wood-Dauphinee, S. L. (1992). Clinical and laboratory measures of postural balance in an elderly population. Archives of Physical Medicine and Rehabilitation,73(11), 1073–1080.PubMedGoogle Scholar
  30. 30.
    Peters, D., Fritz, S., & Krotish, D. (2013). Assessing the reliability and validity of a shorter walk test compared with the 10-Meter Walk Test for measurements of gait speed in healthy, older adults. Journal of Geriatric Physical Therapy,36(1), 24–30. Scholar
  31. 31.
    Jones, C. J., Rikli, R. E., & Beam, W. C. (1999). A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Research Quarterly for Exercise and Sport,70(2), 113–119. Scholar
  32. 32.
    Helbostad, J. L., Taraldsen, K., Granbo, R., Yardley, L., Todd, C. J., & Sletvold, O. (2010). Validation of the falls efficacy scale-international in fall-prone older persons. Age and Ageing,39(2), 259. Scholar
  33. 33.
    Marques-Vieira, C. M. A., Sousa, L. M. M., Severino, S., Sousa, L., & Caldeira, S. (2016). Cross-cultural validation of the falls efficacy scale international in elderly: Systematic literature review. Journal of Clinical Gerontology and Geriatrics,7(3), 72–76. Scholar
  34. 34.
    Tombaugh, T. N., & McIntyre, N. J. (1992). The mini-mental state examination: A comprehensive review. Journal of the American Geriatrics Society,40(9), 922–935. Scholar
  35. 35.
    Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2013). Applied multiple regression/correlation analysis for the behavioral sciences. London: Routledge.CrossRefGoogle Scholar
  36. 36.
    Greene, W. H. (2012). Econometric analysis. Boston: Pearson.Google Scholar
  37. 37.
    Karimi, M., & Brazier, J. (2016). Health, health-related quality of life, and quality of life: What is the difference? Pharmacoeconomics,34(7), 645–649. Scholar
  38. 38.
    Grund, S., Breitinger, E., Fricke, S., Alpers, G. W., Hundsdörfer, W., & Schäfer, H.-G. (2017). Health-related quality of life measurement inpatient geriatric rehabilitation: A comparison of the feasibility and suitability between the SF-36 and EQ-5D-5L questionnaires. Journal of Gerontology & Geriatric Research,6(6), 458. Scholar
  39. 39.
    Sørensen, J., Davidsen, M., Gudex, C., Pedersen, K. M., & Brønnum-Hansen, H. (2009). Danish EQ-5D population norms. Scandinavian Journal of Public Health,37(5), 467–474. Scholar
  40. 40.
    van den Berg, B. (2012). Sf-6d population norms. Health Economics,21(12), 1508–1512. Scholar
  41. 41.
    Christiansen, T., Lauridsen, J. T., Kifmann, M., Lyttkens, C. H., Ólafsdóttir, T., & Valtonen, H. (2018). Healthcare, health and inequality in health in the Nordic countries. Nordic Journal of Health Economics,6(2), 10. Scholar
  42. 42.
    Leegaard, M., Utne, I., Halvorsrud, L., Valeberg, B. T., Torbjørnsen, A., Bjørnnes, A. K., et al. (2018). A review of self-rated generic quality of life instruments used among older patients receiving home care nursing. Health and Social Care in the Community,26(3), e321–e328. Scholar
  43. 43.
    Hickey, A., Barker, M., McGee, H., & O’boyle, C. (2005). Measuring health-related quality of life in older patient populations: A review of current approaches. Pharmacoeconomics,23(10), 971–993. Scholar
  44. 44.
    Brazier, J. E., Walters, S. J., Nicholl, J., & Kohler, B. (1996). Using the SF-36 and Euroqol on an elderly population. Quality of Life Research,5(2), 195–204. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PhysiotherapyOsloMet – Oslo Metropolitan UniversityOsloNorway
  2. 2.Faculty of ManagementUniversity of British Columbia OkanaganKelownaCanada

Personalised recommendations